Year: 2026 | Month: August | Volume: 13 | Issue: 8 | Pages: 449-453
DOI: https://doi.org/10.52403/ijrr.20260845
A Double-Edged Sword of Transfusion: A Post-Hysterectomy Plot Twist - A Case Report
Dr Shreya M S1, Dr Manjunath A C2, Dr Suchetana Mohan3
1,3MD Student, Department of Anesthesiology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore
2Professor, Department of Anesthesiology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore
Corresponding Author: Dr Shreya M S
ABSTRACT
Red blood cell (RBC) transfusion effectively and rapidly corrects severe anaemia but is increasingly recognised to carry short- and long-term risks that extend beyond immunological and infective hazards, including immunomodulation, altered coagulability, and endothelial glycocalyx injury. We describe a 40-year-old woman with severe menorrhagia-related anaemia (haemoglobin 6.9 g/dl) who received five units of packed red blood cells before elective total abdominal hysterectomy. Ultrasound-guided internal jugular vein cannulation failed bilaterally, and a femoral venous catheter was placed; a further internal jugular attempt precipitated acute respiratory distress requiring conversion to general anaesthesia. Hysterectomy was otherwise uneventful. Postoperatively, the patient developed right lower-limb deep vein thrombosis at the femoral catheter site, followed by septic shock, splenic and cerebral infarction, and multi-organ dysfunction; blood and drain cultures grew Serratia marcescens and Escherichia coli respectively. Despite maximal supportive care, she died on postoperative day 5. This case illustrates the sequential, and ultimately fatal, convergence of transfusion-associated hypercoagulability and immunomodulation with catheter-related thrombosis and nosocomial sepsis in a single perioperative course. It highlights the need for judicious transfusion thresholds, preferential avoidance of femoral venous access, and heightened postoperative surveillance for thrombotic and septic complications in transfused surgical patients.
Keywords: Red blood cell transfusion; venous thromboembolism; endothelial glycocalyx; hysterectomy; perioperative sepsis; case report
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